(By David Sanders, Professor and founding Director of the School of Public Health at the University of the Western Cape, South Africa. He is a founder member and on the Global Steering Council of the People’s Health Movement (PHM) and is currently chairperson of PHM South Africa.)
A few weeks ago, the conference on social determinants took place in Rio. As David Sanders from the University of the Western Cape (South Africa) played a prominent role there, we invited him to write down what he said on the stage. He referred us to the following website, which provides a good verbatim account of his opening remarks in a panel. Here we offer them again in full, as they only seem to become more relevant over time. You can also find a YouTube video on the session here.
I want to focus on mothers and children in particular. There is an unacceptable gap between rich and poor. A woman in a poor country has a one in ten chance of dying in childbirth. A total of 35 per cent of deaths of children in the world are due to malnutrition.
What are we doing about this? Very little. Trade is sadly not mentioned in the Rio Declaration. Undernutrition is related to free trade agreements. Northern countries subsidise their agriculture and export food to impoverished countries, flooding their markets. For example, Japan subsidises its dairy industry to the tune of $US 2,600 a year per cow. Why should a Japanese cow enjoy an annual ‘income’ of five times that of an African citizen who earns on average $US 500 a year? And this leads to food insecurity. Why are we not talking about these things?
What is UNICEF doing about this? It is flying Plumpy’nut from France into Africa to treat malnutrition. This medicalises the problem and draws attention away from the fact that African countries import food and sell land to transnational food companies. Ethopia, the largest recipient of Plumpy’nut, also receives 700,000 tonnes of food aid a year. It has just sold 3 million hectares of prime land to a food transnational corporation.
This is the context of the problem and we are not addressing it. Looking at non-communicable diseases, again trade is the issue. South Africa is the third fattest country in the world; and the importation and production of processed food products, and of whey, an ingredient of snacks, has gone up exponentially. How are we going to control malnutrition without regulating trade?
Also, there is no reference in the Rio Declaration to the unfair trade of health personnel. Africa and Asia have been stripped of health personnel and that is very unequal trade, contributing to an increase in maternal mortality among other things, since skilled health personnel are crucial to reducing this tragedy. It was estimated several years ago by UNCTAD (the UN Conference on Trade and Development) that the US saves $US 184,000 in training costs for each imported professional. Totalled up, this translates into hundreds of billions of dollars. Again here is the South subsidising the North. We need compensation for what African ministers of health a few years ago called brain robbery – not a voluntary code, like the present WHO code on recruitment, which has no teeth to enforce it.
I am also member of the People’s Health Movement, a global movement active in about 70 countries, with several affiliated organisations. We have a position in PHM of unconditional but critical support of the UN agencies. Although they are imperfect, they represent the views of the member states. However, they have been weakened substantially because countries are not funding them as they should. They should also be strengthened and they should be bolder. But private initiatives such as the Gates Foundation are major funders and they are influencing these agencies to a great extent.
As Bob Dylan said, money doesn’t talk, it swears. We need to speak about the financial crisis, a food crisis and a climate crisis (and climate is not mentioned in the Rio Declaration). The financial crisis is a crisis of capitalism. There is an alternative Rio declaration put up by civil society, with ten very clear demands, including a Tobin tax. Why aren’t United Nations agencies calling for this? This is not a radical thing, it’s a tax on the casino economy. Now poor people everywhere, including in Southern Europe, are paying for the crisis. We should stand up for them.